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Minocycline drug-induced pigmentation in Adult
Other Resources UpToDate PubMed

Minocycline drug-induced pigmentation in Adult

Contributors: Erik Domingues MD, Nikki Levin MD, Jeffrey D. Bernhard MD
Other Resources UpToDate PubMed


Drug-induced pigmentation caused by minocycline may affect the skin, mucosal surfaces, teeth, tongue, sclera, bone, heart, thyroid, and other locations. Minocycline is a tetracycline-derived antibiotic with various uses, most notably as a second-line treatment for acne vulgaris. Hyperpigmentation may follow ingestion of 100-200 mg/day for 1-3 years, and incidence rates vary from 2.4%-14.8%. However, some studies have demonstrated the development of hyperpigmentation following small doses and short courses of minocycline.

The incidence seems highest in patients with conditions such as atopic dermatitis, acne vulgaris, rheumatoid arthritis, pemphigoid, and pemphigus.

Four types of hyperpigmentation have been described: types I–IV. Each type varies in distribution and histology. (For type details, refer to Look For section.)

Pediatric Patient Considerations:
Children aged younger than 9 years should not be on medications from the tetracycline family of antibiotics.


T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

110284009 – Drug-induced pigmentation

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Drug-induced pigmentation (antimalarials) – brown, gray-brown, blue-black, yellow, or yellow-green pigmentation may occur with use of more than 1 year; may affect the nail beds
  • Drug-induced flagellate pigmentation  – bleomycin and other chemotherapy
  • Amiodarone drug-induced pigmentation – initially shows dusky-red erythema with eventual progression to a blue-gray pigmentation of sun-exposed areas
  • Melasma (chloasma)
  • Postinflammatory hyperpigmentation has history of preceding inflammation.
  • Phytophotodermatitis
  • Fixed drug eruption
  • Large plaque parapsoriasis
  • Generalized hyperpigmentation is also seen in Addison disease, Cushing syndrome, Scleroderma, Wilson disease, Hemochromatosis, Chronic kidney disease, Porphyria cutanea tarda, Vitamin B12 deficiency, Pellagra, Ochronosis, Gaucher disease type 1, and Carcinoid syndrome.
  • Erythema ab igne
  • Ashy dermatosis (Ashy dermatosis)
  • Confluent and reticulated papillomatosis (Gougerot-Carteaud syndrome)
  • Cutaneous T-cell lymphoma
Immunocompromised Patient Differential Diagnosis:
  • Human immunodeficiency virus (HIV)-infected patients and AIDS patients on zidovudine may develop brown macules on the oral mucosa or lips and longitudinal brown bands on nails.

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:02/20/2018
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Patient Information for Minocycline drug-induced pigmentation in Adult
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Minocycline drug-induced pigmentation in Adult
A medical illustration showing key findings of Minocycline drug-induced pigmentation : Blue color, Brown color, Face, Hyperpigmented patch, Leg
Clinical image of Minocycline drug-induced pigmentation - imageId=340188. Click to open in gallery.  caption: 'A close-up of pinpoint dark gray and black macules.'
A close-up of pinpoint dark gray and black macules.
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